To describe the link between adipocytes and cardiometabolic risk and present mechanisms by which obesity contributes to dysglycemia, dyslipidemia, hypertension, and a prothrombotic, inflammatory state favoring atherogenesis. Review of relevant literature compiled via a literature search (PUBMED) of English-language literature publications between 1994 and 2010. Cardiometabolic risk is a term that includes a series of conditions and factors, which contribute to increased risk of developing atherosclerosis. Cardiometabolic risk encompasses traditional coronary risks factors such as smoking, arterial hypertension, diabetes, obesity, elevated cholesterol, old age, male gender, and a positive family history of early coronary events plus additional contributing factors such as insulin resistance, atherogenic dyslipidemia, physical inactivity, unhealthy eating, inflammation, and hypercoagulable state. Adipocyte accumulation and dysfunction contribute to most, if not all, of the cardiometabolic risk factors. A number of different pathologic mechanisms through which adipocytes contribute to cardiometabolic risk and promote atherosclerosis are reviewed. Dysfunctional adipocytes are associated with the development of insulin resistance, hyperglycemia, atherogenic dyslipidemia and arterial hypertension, and favor a prothrombotic and proinflammatory state. Adipocytes dysfunction increases cardiometabolic risk through a variety of mechanisms.